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      A study of nerve conduction velocity in diabetic patients and its relationship with tendon reflexes (T-Reflex)

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          Abstract

          Background and Objective:

          Neuropathy is one of the most common complications of diabetes mellitus. Neuropathy can cause sensory deficit, neurological disorder, organ ulcers, osteomyelitis, and amputation. Therefore, neurological examinations, determining the nerve conduction velocity and performing sensory and motor tests are important for timely diagnosis and treatment. The present study aimed to investigate the nerve conduction velocity in diabetic patients and its relationship with tendon reflexes.

          Materials and Methods:

          The present study was observational-cross sectional research carried out on 77 diabetic patients who admitted to the EMG / NCV Department of Shariati Hospital in the academic year 1996-1997. In all patients, the medical history of the patient (age, duration of diabetes, gender and age of onset of diabetes), neurological examination, nerve conduction velocity, heat test, vibration test, tendon reflexes, D.L and Amplitude were examined and recorded. Finally, the raw data obtained was entered into the IBM SPSS Statistics software and the important relationships between these variables were analyzed. Moreover, in present study, the statistical significance level (P-value) was considered less than 0.05.

          Results:

          The present study was conducted on a population consisting of 48 women and 29 men with diabetes. The age range of participants was 14-70 years old with an average age of 50.506 ± 7.50. The results of present study showed that the participants with clinical neuropathy (11.2 ± 7.2) had significantly longer duration of diabetes than the normal group and those participants with sub-clinical neuropathy (P-value = 0.12). Statistical analyses indicated that increase in age, increase in the duration of diabetes and the gender of male significantly made the nerve conduction velocity abnormal. The analysis of the response to neural reflexes indicated that the ratio of neurological disorders in the five nerves of the ankle and knee was generally higher in the abnormal group (the patients with nerve conduction disorder) compared to the normal (the patients with normal nerve conduction) and in some cases, such as the ulnar motor nerve of ankle (P-value = 0.010), and the ulnar motor nerve of knee motor (P-value = 0.002) and also in the peroneal motor nerve of knee (P-value = 0.003) and the sural sensory nerve of knee (P-value = 0.003), increase in neurological disorders was significant.

          Conclusion:

          Increase in age, increase in the duration of diabetes and the gender of male can significantly make the nerve conduction velocity abnormal. (www.actabiomedica.it)

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          Most cited references19

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          Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis.

          To determine the efficacy and safety of 600 mg of alpha-lipoic acid given intravenously over 3 weeks in diabetic patients with symptomatic polyneuropathy. We searched the database of VIATRIS GmbH, Frankfurt, Germany, for clinical trials of alpha-lipoic acid according to the following prerequisites: randomized, double-masked, placebo-controlled, parallel-group trial using alpha-lipoic acid infusions of 600 mg i.v. per day for 3 weeks, except for weekends, in diabetic patients with positive sensory symptoms of polyneuropathy which were scored by the Total Symptom Score (TSS) in the feet on a daily basis. Four trials (ALADIN I, ALADIN III, SYDNEY, NATHAN II) comprised n=1258 patients (alpha-lipoic acid n=716; placebo n=542) met these eligibility criteria and were included in a meta-analysis based on the intention-to-treat principle. Primary analysis involved a comparison of the differences in TSS from baseline to the end of i.v. Treatment between the groups treated with alpha-lipoic acid or placebo. Secondary analyses included daily changes in TSS, responder rates (> or =50% improvement in TSS), individual TSS components, Neuropathy Impairment Score (NIS), NIS of the lower limbs (NIS-LL), individual NIS-LL components, and the rates of adverse events. After 3 weeks the relative difference in favour of alpha-lipoic acid vs. placebo was 24.1% (13.5, 33.4) (geometric mean with 95% confidence interval) for TSS and 16.0% (5.7, 25.2) for NIS-LL. The responder rates were 52.7% in patients treated with alpha-lipoic acid and 36.9% in those on placebo (P<0.05). On a daily basis there was a continuous increase in the magnitude of TSS improvement in favour of alpha-lipoic acid vs. placebo which was noted first after 8 days of treatment. Among the individual components of the TSS, pain, burning, and numbness decreased in favour of alpha-lipoic acid compared with placebo, while among the NIS-LL components pin-prick and touch-pressure sensation as well as ankle reflexes were improved in favour of alpha-lipoic acid after 3 weeks. The rates of adverse events did not differ between the groups. The results of this meta-analysis provide evidence that treatment with alpha-lipoic acid (600 mg/day i.v.) over 3 weeks is safe and significantly improves both positive neuropathic symptoms and neuropathic deficits to a clinically meaningful degree in diabetic patients with symptomatic polyneuropathy.
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            Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy.

            Diabetic peripheral neuropathy (DPN) affects up to 50% of patients with diabetes and is a major cause of morbidity and increased mortality. Its clinical manifestations include painful neuropathic symptoms and insensitivity, which increases the risk for burns, injuries and foot ulceration. Several recent studies have implicated poor glycaemic control, duration of diabetes, hyperlipidaemia (particularly hypertryglyceridaemia), elevated albumin excretion rates and obesity as risk factors for the development of DPN. Although there is now strong evidence for the importance of nerve microvascular disease in the pathogenesis of DPN, the risk factors for painful DPN are not known. However, emerging evidence regarding the central correlates of painful DPN is now afforded by brain imaging. The diagnosis of DPN begins with a careful history of sensory and motor symptoms. The quality and severity of neuropathic pain if present should be assessed using a suitable scale. Clinical examination should include inspection of the feet and evaluation of reflexes and sensory responses to vibration, light touch, pinprick and the 10-g monofilament. Glycaemic control and addressing cardiovascular risk is now considered important in the overall management of the neuropathic patient. Pharmacological treatment of painful DPN includes tricyclic compounds, serotonin-norepinephrine reuptake inhibitors (e.g. duloxetine), anticonvulsants (e.g. pregabalin), opiates, membrane stabilizers, the antioxidant alpha lipoic acid and others. Over the past 7 years, new agents with perhaps less side effect profiles have immerged. Management of patients with painful neuropathy must be tailored to individual requirements and will depend on the presence of other co-morbidities. There is limited literature with regard to combination treatment. Copyright © 2012 John Wiley & Sons, Ltd.
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              Motor dysfunction in diabetes.

              Neuropathy is a frequent complication in diabetes and most commonly seen as distal symmetrical sensorimotor polyneuropathy (PN). Involvement of the motor system is infrequently seen at the clinical examination. However, with the application of quantitative techniques, that is, isokinetic dynamometry, type 1 and type 2 diabetic patients have been detected to have weakness at the ankle and the knee. Muscle weakness is found only in diabetic patients with PN, while non-neuropathic patients even with long-term diabetes have normal strength. The weakness is closely related to signs and severity of PN. With the use of magnetic resonance imaging, muscle weakness is found to be paralleled by muscular atrophy, which is observed in the feet and at the lower leg. Following diabetic patients for 8-10 years, we have observed accelerated loss of muscle strength in patients with symptomatic PN; similarly, accelerated loss of muscle mass is observed in the feet and lower legs. In large-scale studies of diabetic and non-diabetic subjects, lower muscle quality in diabetic patients is also found. Thus, in addition to PN, diabetes per se leads to lower strength per unit striated muscle. Muscle weakness is related to the slowing of movements, unstable gait, and more frequent falls. Furthermore, motor dysfunction leads to an increased risk of developing a foot ulcer due to due to alterations of the biomechanics of the feet caused by muscle atrophy. This may lead to an increased skin pressure that may lead to foot ulceration and ultimately amputation. Muscle and balance training may improve strength, postural stability, and walking performance; however, this needs to be studied in more detail. Copyright © 2012 John Wiley & Sons, Ltd.

                Author and article information

                Journal
                Acta Biomed
                Acta Biomed
                Acta Bio Medica : Atenei Parmensis
                Mattioli 1885 (Italy )
                0392-4203
                2531-6745
                2020
                25 August 2020
                : 91
                : 3
                : e2020066
                Affiliations
                Department Neurology, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
                Author notes
                Correspondence: Khadijeh Haji Naghi Tehrani, Department Neurology, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran Tel: 00989121493324 E-mail: drkhadijehtehrani@ 123456yahoo.com
                Article
                ACTA-91-66
                10.23750/abm.v91i3.7288
                7716994
                32921766
                fdaa6917-4f81-4b3f-97e0-95115526f626
                Copyright: © 2020 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                : 21 April 2018
                : 22 February 2020
                Categories
                Original Article

                diabetes,neuropathy,neurological disorder,nerve conduction velocity,tendon reflex.

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